Transvaginal access for NOTES: a cohort study of microbiological colonization and contamination.

BACKGROUND AND STUDY AIMS: Animal data and limited clinical evidence suggest a low incidence of infection following transvaginal natural orifice transluminal endoscopic surgery (NOTES). However, a systematic microbiological evaluation has not yet been carried out. The aim of this prospective cohort study was to evaluate the extent of microbiological contamination of the peritoneal cavity caused by the transvaginal access for NOTES and the impact of preoperative vaginal disinfection on vaginal colonization. PATIENTS AND METHODS: Consecutive female patients with symptomatic cholecystolithiasis were offered either transvaginal rigid-hybrid cholecystectomy (tvCCE) or conventional laparoscopic cholecystectomy. Patients who opted for tvCCE were prospectively evaluated between February and June 2010. Disinfection in patients undergoing tvCCE included hexetidine tablets and octenidine applied vaginally. All patients received a single dose of perioperative cefuroxime. Swabs were obtained from the posterior fornix and the peritoneal cavity at different intervals. RESULTS: Of 32 patients, 27 (84 %) opted to undergo tvCCE. One patient (4 %; 95 % confidence interval [CI] 0.7 % - 18.3 %) had a positive bacterial culture in the Douglas pouch prior to transvaginal access compared with two patients (7 %; 95 %CI 2.1 % - 23.4 %) following colpotomy closure (P = 1.000). Vaginal disinfection significantly decreased vaginal bacterial load (P = 0.001) and bacterial growth in routine cultures (P < 0.001); in 16 patients (59 %; 95 %CI 40.7 % - 75.5 %) vaginal swabs were sterile after disinfection. No postoperative surgical site infections occurred (95 %CI 0 % - 12.5 %). CONCLUSIONS: In selected patients and following vaginal antisepsis, transvaginal access for NOTES is associated with microbiological contamination of the peritoneal cavity in a minority of patients, indicating a low risk of peritoneal contamination caused by the transvaginal access.

The effect of hexetidine mouthwash on the prevention of plaque and gingival inflammation: a systematic review.

OBJECTIVE: To review the literature concerning hexetidine-containing mouthwash as a monotherapy or as an adjunct to oral hygiene in the prevention of plaque accumulation and gingival inflammation. MATERIALS AND METHODS: PubMed-MEDLINE and the Cochrane-CENTRAL were searched through January 2010 to identify appropriate studies. The primary outcome measurements were plaque accumulation and gingivitis parameters. RESULTS: Independent screening of titles and abstracts of 168 papers resulted in six publications that met the eligibility criteria. Mean values and standard deviations were obtained by data extraction. Descriptive comparisons are presented for hexetidine mouthwash and control mouthwashes (chlorhexidine and placebo). CONCLUSIONS: Considering the potential benefits in the light of the observed side effects, hexetidine appears to be a poor alternative to chlorhexidine.

The plaque inhibitory effect of a CPC mouthrinse in a 3-day plaque accumulation model - a cross-over study.

OBJECTIVE: To test the plaque inhibitory effect of an experimental 0.07% cetylpyridinium chloride (CPC) mouthrinse in a 3-day plaque accumulation model in a cross-over design. MATERIAL AND METHODS: A total of 30 subjects (non-dental students), ≥18 years of age, were randomly assigned to use one of three different mouthrinses three times a day. After 3 days, the subjects returned for the clinical assessments and received a questionnaire to evaluate their attitude towards the product used by them. The cross-over procedure was repeated twice to have all subjects use all products. RESULTS: A total of 29 subjects completed the protocol and this resulted in a statistically significant difference between the three groups (P < 0.001) with regard to plaque scores. Over three sessions, the mean plaque scores were 2.17 for the control product, 1.14 for the CPC group and 1.12 for the 0.1% Hexetidine product (positive control). Results of the questionnaire show that, compared with hexetidine, the taste of the CPC was appreciated better, and less oral sensations were observed following rinsing. CONCLUSION: The CPC mouthrinse proved to be effective in inhibiting 'de novo' plaque formation to an extent similar to that of a 0.1% hexetidine product. Compared with hexetidine, the taste of the CPC was appreciated better and less oral sensations were observed following rinsing.

[Combined local therapy in oropharyngeal diseases].

A pilot trial of efficacy of the drugs lisobact and stomatidin in local treatment of acute pharyngitis and combined therapy of tonsillitis and paratonsillar abscess included 82 patients with tonsillitis (n=30), paratonsillar abscess (n=30) and acute pharyngitis (n=22) aged 15-72 years. Effectiveness of the treatment was assessed by changes in clinical symptoms, pharyngoscopic picture and results of bacteriological studies. It was found that treatment with lisobact and stomatidin diminished considerably bacterial contamination of the paratonsillar abscess and pharyngeal mucosa. Local treatment with lisobact and stomatidin for paratonsillar abscess in combination with systemic antibacterial drug reduces the time of hospital stay, in tonsillitis patients - of disability. High compliance to lisobact and stomatidin treatment was observed.

[Efficacy of an antiseptic dialysis of purulent wounds in the dentofacial region with hyvalix].

The article presents data proving the possibility of using the solutions of "Hyvalix" medication for an antiseptic preparation of septic cavities after lancing of abscesses and phlegmons of dentofacial region. It was shown the efficacy of "Hyvalix" medication in comparison with traditional solutions of antiseptic means.

Clinical study on the effectiveness and side effects of hexetidine and chlorhexidine mouthrinses versus a negative control.

OBJECTIVES: The aim of this clinical, controlled double-blind trial was to evaluate the effectiveness and side effects of two different mouthrinses. METHOD AND MATERIALS: Ninety subjects with gingivitis (or slight periodontitis) were randomly allocated to three groups: group 1, Chlorhexamed (0.1% chlorhexidine); group 2, Hexoral (0.1% hexetidine); and group 3, a placebo-control compound. The subjects were instructed on how to use the mouthrinse. At baseline, as well as after 2 and 4 weeks, the Approximal Plaque Index (API), the Bleeding Index (BI), the Community Periodontal Index of Treatment Needs, the Gingival Index (GI), and the Discoloration Index (DI), were measured. Statistical analysis was carried out with the Kruskal-Wallis test, Fisher's exact test, and Wilcoxon test. RESULTS: In group 1, the mean API improved significantly (P < or = .001) after 4 weeks. The mean BI was reduced significantly, as was the GI. In group 2, the mean API and the mean BI both decreased significantly, and a statistically significant reduction of the GI was also seen. In group 3, significant improvements of the mean values of all parameters were documented after 4 weeks. When comparing group 3 with groups 1 and 2, the difference in the reduction of the API was statistically significant (P < .002). No statistical difference could be shown when comparing groups 1 and 2. Regarding the improved results of the BI and the GI, no statistically significant difference was found in the effectiveness of all 3 compounds. All 3 groups showed some increase in the mean DI after 4 weeks. Comparing groups 1 and 2 directly, the difference in the increase in the discoloration of the teeth was statistically significant (P = .0035). There was no statistical difference in the mean discoloration scores comparing groups 2 and 3. CONCLUSION: This double-blind clinical trial demonstrated Hexoral to be a useful alternative to Chlorhexamed mouthrinse, as well as one causing less discoloration.

Antiplaque and antigingivitis effectiveness of a hexetidine mouthwash.

OBJECTIVE: To assess the antiplaque/antigingivitis efficacy of a hexetidine-containing mouthwash. METHODS: This examiner-blind, parallel group, controlled clinical study examined the effectiveness of a hexetidine (0.1%) mouthwash both in inhibiting the development of supragingival plaque and in reducing gingivitis. One hundred and thirty-four adult subjects completed the 2-week experimental gingivitis model study. Following baseline examinations, which included plaque index, modified gingival index and gingival bleeding index, subjects received a full dental prophylaxis. Subjects were randomly assigned to one of three mouthwashes (hexetidine 0.1%, chlorhexidine 0.12% (positive control) or a 5% hydroalcohol negative control) and commenced three times daily supervised rinsing as their sole method of oral hygiene. All indices were rescored after 2 weeks. RESULTS: Compared to the negative control group, the hexetidine group demonstrated a statistically significant inhibition and reduction of supragingival plaque and gingival inflammation with reductions of 6.3%, 33.5% and 56% for gingivitis, plaque and gingival bleeding, respectively. The results of the chlorhexidine group were used to validate the study. CONCLUSION: The study confirms the efficacy of a hexetidine rinse in reducing supragingival plaque and gingival inflammation.

Prevention of nosocomial infection in a pediatric intensive care unit (PICU) through the use of selective digestive decontamination.

OBJECTIVE: To assess the effectiveness of selective digestive decontamination (SDD) on the control of nosocomial infection (NI) in critically ill pediatric patients. DESIGN: A prospective, randomized, non-blinded and controlled clinical microbiology study. SETTING: The pediatric intensive care unit (PICU) of a tertiary level pediatric university hospital. CRITERIA FOR INCLUSION: Patients 1 month to 14 years old, who underwent some kind of manipulation or instrumentation (mechanical ventilation, vascular cannulation, monitoring of intracranial pressure, thoracic or abdominal drainage, bladder catheterization, peritoneal dialysis, etc.) and/or presented a neurological coma requiring a stay in the PICU of 3 or more days. PATIENTS: Over a period of 2 years, 244 patients met the inclusion criteria; 18 patients were withdrawn because of protocol violation. The treatment group comprised 116 patients and the control group, 110 patients. INTERVENTION: The treatment group received a triple therapy of colimycin, tobramycin and nystatin administered orally or via nasogastric tube every 6 hours. All patients with mechanical ventilation or immune-depression received decontamination treatment of the oropharyngeal cavity with hexitidine (Oraldine 0.5 mg/ml) every 6-8 hours in accordance with the PICU's conventional protocol. METHOD: Up to 10 types of nosocomial infection were diagnosed following criteria of the Centers for Disease Control (CDC). The severity and manipulation of the patients on admission was assessed using the therapeutic intervention scoring system (TISS) and multi-organ system failure scores (MOSF). MEASUREMENTS AND MAIN RESULTS: UNIVARIANT ANALYSIS: SDD did not significantly reduce the incidence of NI, antibiotic use, the length of stay, or mortality; although a small percentage of respiratory and urinary tract infections was detected, catheter-related bacteremia was the most common infection. MULTIVARIANT ANALYSIS: Controlling the risk factors for each child through log regression showed that SDD acted as a protective factor for more than 90% of the sample with respect to the appearance of respiratory and urinary tract infections, reducing the risk of such infections to 1/5 and 1/3, respectively. CONCLUSIONS: SDD was effective in controlling respiratory and urinary tract infections in children admitted to the PICU, but it did not reduce the incidence of other types of nosocomial infection.

Protective effect of hexetidine against in vitro bacterial demineralisation of bovine enamel and dentin in the presence of fluoride.

Bovine enamel and dentin specimens were overlaid with acidogenic Streptococcus mutans suspensions in agarose. In this model, the minimal demineralisation-inhibiting concentrations (MDIC) of hexetidine was determined in the presence of fluoride. A commercially available mouthwash containing 0.1% (2.9 mmol/l) hexetidine was diluted serially and added to the bacterial suspensions together with 0, 5.3, or 26.3 mumol/l fluoride (NaF). After 22 h of incubation at 37 degrees C the bacterial suspensions were removed and assessed for calcium and lactate. The results showed significant inhibitory effects of hexetidine on the demineralisation of the enamel specimens with a MDIC between 15 and 31 mumol/l hexetidine. In the presence of fluoride, approximately fourfold higher concentrations of hexetidine were needed for a significant additional protection of the enamel. No synergistic effect between hexetidine and fluoride was observed. For the demineralisation of the dentin specimens, the MDIC of hexetidine had a value between 31 and 61 mumol/l. At both these concentrations the dentin specimens were relatively less protected in the presence than in the absence of fluoride, and some synergistic effect between hexeditine and fluoride was observed.

The effect of hexetidine spray on dental plaque following periodontal surgery.

The aim of the present study was to determine the effects of a 0.2% hexetidine spray, used as a supplement to regular oral hygiene measures, on dental plaque and gingival condition following periodontal surgery. This study was carried out on 38 patients who required 2 episodes of periodontal surgery. Examinations regarding dental plaque were performed at 0, 7, 14, 21 and 28 days, while the condition of the gingiva were examined at 0 and 28 days. Dental plaque was assessed by the Turesky modification of Quigley-Hein index; the gingival condition was evaluated using the gingival index of Löe-Silness and the papilla bleeding index. In a double-blind cross-over study of 28 days duration, significant reduction in plaque accumulation and an improvement in wound healing were demonstrated for the test spray compared to the placebo.

[Mouth care in intubated patients with nothing-by-mouth diet in an in tensive care unit]. / Higiene de la boca en pacientes intubados o con dieta oral absoluta en una Unidad de Cuidados Intensivos

The objective of this study is to value the effectiveness of a care plan of mouth care and at the same time, compare the effects of the use of two different solutions: physiologic serum and non-diluted hexetidine (Oraldine). The sample studied was formed by 40 intubated patients or patients with an absolute oral diet who were in the Intensive Care Unit of the University Clinic. 50% of the patients underwent oral hygiene with physiological serum, following the established protocol and the other 50% were treated with non-diluted hexetidine with a frequency of five times a day. The mouth status was checked at the moment of admission and then daily: lips, tongue, gums, palate, presence of residua and saliva characteristics. Also, a series of factors which could alter the buccal integrity were registered: oxygenotherapy, orotraqueal intubation, anemia, plaquetopenia, medicines, etc. Bacteriological controls of traqueal secretion were performed periodically. From the analysis of the results we can conclude that the care plan established is efficient, although it is not enough for patients with coagulation alterations (plaquetopenia). From the solutions used for oral hygiene we can say that although there have not been significant differences, the physiologic serum is the chosen product, as it maintains the mouth status better and helps to keep the oral microbiota.

An approach to efficacy screening of mouthrinses: studies on a group of French products (II). Inhibition of salivary bacteria and plaque in vivo.

The aim of this study was to determine the value of screening studies to assess the efficacy of antiseptic mouthrinse products relative to proven products. The products tested were 6 antiseptic mouthrinses available in France. 4 contained chlorhexidine (Eludril, Hibident, Parodex and Prexidine) with Hibident considered the positive control. 1 product contained cetylpyridinium chloride (Alodont) and 1 hexetidine (Hextril). Saline was used as the negative control. The 1st study assessed the persistence of action of the products by recording salivary bacterial counts before and up to 7 h after single rinses. The 2nd study measured the inhibition of plaque regrowth, from a zero baseline, in the absence of tooth-brushing over a 4-day period. Both studies used blind randomised crossover designs balanced for residual effects. Salivary bacterial count reductions with time were highly significantly greater for Parodex to 5 h and Hibident and Prexidine to 7 h; There were no significant differences between the latter three chlorhexidine rinses except at 3 h, when decrements were significantly less with Parodex. Despite a mean trend in favour, Alodont, Eludril and Hextril were not significantly different from saline. Plaque inhibition by area and index was highly significantly different between products. Hibident, Parodex and Prexidine showed similar plaque inhibition and were significantly more effective than all other rinses. Eludril and Hextril were significantly more effective than saline but Alodont was not. Taken with the associated study in vitro and published reports on the same or similar products, it is apparent that efficacy of a product cannot be assumed merely because it contains a known active plaque inhibitor.(ABSTRACT TRUNCATED AT 250 WORDS)

Hexetidine mouthrinse in the management of minor aphthous ulceration and as an adjunct to oral hygiene.

A number of compounds have been used in the management of recurrent oral ulceration, including antimicrobials. This was a double-blind placebo-controlled cross-over study to assess the value of a 0.1% hexetidine mouthwash in the management of minor aphthous ulceration and as an adjunct to oral hygiene. Forty patients with a catalogued history of ulceration took part. Patients were randomly allocated to active/placebo or vice versa order of mouthwashes, which were used as 15 ml volumes three times a day. Treatment periods were 6 weeks with a 3 week washout. During each period patients kept daily records of the number, site, and duration of ulcers, together with pain scores. Plaque and gingivitis were scored at baseline and end of treatment periods. Thirty-eight patients completed the study, with no significant treatment differences between active and placebo rinses on any ulcer parameter. Additionally, the hexetidine rinse provided no significant benefit to oral hygiene or gingival health. However, there was a significant period effect, with considerable ulcer improvements during the second period, irrespective of treatment. In conclusion, the hexetidine rinse appeared to offer no benefits to these patients, but professional supervision of ulcer treatment does appear to result in a worthwhile placebo effect.

Comparison of the effect of toothpastes containing enzymes or antimicrobial compounds with a conventional fluoride toothpaste on the development of plaque and gingivitis.

Many toothpastes have been formulated over recent years to contain antimicrobial compounds with the aim of preventing or reducing plaque, calculus, gingival inflammation or dental caries. For many, if not all of these toothpastes, it has yet to be proven whether they are significantly better at reducing plaque and gingivitis than conventional toothpastes, for which no such therapeutic effects have been claimed. This 12-day, incomplete block designed, cross-over study compared the development of plaque and gingivitis following rinsing with toothpaste slurries containing the following active ingredients: (1) hexetidine/zinc citrate, (2) 0.2% triclosan, (3) amyloglucosidase/glucose oxidase, (4) sodium fluoride/sodium monofluorophosphate (NaF, MFP). By the 8th day of the study, a significant difference in gingival crevicular fluid (GCF) and GI was found between the groups. By day 12, however, no significant difference in plaque index and gingival inflammation was found between the 4 toothpastes, although plaque area was significantly reduced with the hexetidine/zinc citrate paste when compared to the conventional fluoride paste. It was concluded that the active ingredients added to the toothpastes evaluated in this study provided little or no more additional benefit to oral hygiene and gingival health than could be achieved with a conventional fluoride toothpaste.

[Clinically controlled, integrated study on plaque inhibition with zinc-fluoride-hexetidin]. / Klinisch-kontrollierte Verbundstudie zur Plaquehemmung von Zinkfluoridhexietidin.

This study investigated the effect of Zinc-Fluorid-Hexetidin comparing with positive control group (Chlorhexidin) and negative control group (experimental gingivitis). The result demonstrated that a mouthrinse containing Zinc-Fluorid-Hexetidin prevented the development of plaque without complications.

The effect of interdental continuous loop wire splinting and intermaxillary fixation on the marginal gingiva.

To study the influence of interdental loop-wire splinting and intermaxillary fixation on the marginal gingiva, 30 patients were evaluated clinically using different periodontal parameters, at 5 examination times. It was shown that despite a standardized oral hygiene regime including the use of a mouthrinse, gingival inflammation occurred for the duration of the splinting period. Factors other than the presence of limited plaque, such as gingival trauma due to splint application and subsequent mechanical irritation should be considered as possible aetiological factors. All investigated marginal gingival changes had totally reversed 2 weeks following loop-wire splint removal, apart from tooth mobility which did not re-attain pre-operative levels, the difference, however, being statistically insignificant.